#268 | Navigating Infant Food Reactivity in the Breastfed Baby with Dr. Trill @Free.To.Feed

June 5, 2024

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Dr. Trillitye Paullin is a molecular biologist and founder of Free to Feed, a consultation service for navigating infant food reactivity in breastfeeding dyads. Today, Dr. Trill joins us with one of her clients, Chelsea, a first-time mom who found Trill and our podcast and reached out to help spread the research around newborn food reactivity. Trill shares her ground-breaking research into why and how a mother's diet causes allergic responses in babies in the form of bloody stools, skin rashes, vomiting, reflux and colic-like symptoms. With around 25% of parents reporting food allergy symptoms in their babies, these issues have been grossly underserved and misunderstood for decades. We cover: 

  • The top 12 foods causing allergy symptoms;
  • The timing of protein transfer, reactivity, and gut healing;
  • How our gastrointestinal health impacts infant food allergies;
  • How stress and cortisol impact the transfer of proteins into milk.

Stanford University and Free to Feed have embarked on a transformative partnership to develop tools aimed at accurately identifying and managing pediatric food allergies. This collaboration, part of the "Improving Outcomes for Food-Allergic Children" project led by Dr. Trillitye Paullin and supported by Stanford’s Data Science for Social Good Program, seeks to enhance care quality while preventing unnecessary dietary restrictions for children. By integrating these tools into clinical practice and fostering enhanced awareness among providers, the initiative promises to improve health outcomes for children and provide significant insights into the complexities of food allergies, shaping future policies in pediatric healthcare.

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View Episode Transcript

And I specifically said that I wanted to keep breastfeeding my daughter, because my daughter was failing to gain weight at this time as well. And the pediatrician, a male looked at my daughter and he goes all sweetie, do you have an eating disorder. And I am a first time mom, recovering from a C section, I am in this pediatricians office without my husband. I'm a wreck. And I'm just doing everything in me to keep it together. And I left with samples of formula and that that was the solution. When you're navigating this, what we have is a tool that I can go in and say, Chelsea's baby has skin reactions, vomiting and excessively mucousy stool, and then it'll populate based on all of our data. These are the specific foods for her based on her symptoms that are most likely to elicit an allergic response. If Chelsea's little one was experiencing vomiting, the top four foods for her are dairy, soy, and then rice and oats in that order.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hello, everybody, my name is Dr. trill Pollan. I am a molecular biologist by trade, I have a PhD in cellular and molecular biology. And my focus is on the molecular components of human milk, specifically, how we transfer food that we consume from our mouth to our breast. And the journey, if you will, of that career choice started when my oldest daughter was born. And I was finishing my last year of grad school, which is a super fun time to have a baby while you're writing a dissertation and trying to graduate to so she knows, right there radio. Yes. My first was born two weeks before my final exams of my last year. Oh my God, that's cool. Yes, yeah, I remember being just like feeling like I was gonna pop any moment and trying to write the dissertation and get the defense scheduled. So yeah, I feel you in my soul. And I focused on protein analysis in grad school. And in my last year, when we had our daughter, she had severe reactions to proteins transferred from my diet to my breast milk. And even as an expert in the field of proteomics, I had no idea that was even something that could happen. And we navigated excessively bloody stool and controllability. Eventually, the eczema on our skin got so bad that it was weeping and infected. And that really changed the course of my career when my second daughter was born, and she started presenting with very similar issues this time, more so vomiting, and upper GI reactions. And all of the irony in the world at the same time, I was running a lab through the reprocessing facility, and learned that the industry had a simple test that we could use to test cow's milk for cross contamination of other allergens in the facility. And this was the birth if you will, free to feed. So I started free to feed a few weeks postpartum with our second daughter, because I was incredibly shocked and appalled at the fact that I found lots of other families who are navigating this, but that there were no resources and research specifically that I could hold on to and try to get through this journey. Round two. And I did not think that I was going to survive it a second time around because the first time was so very hard. And that eventually led me to starting free to feed and helping 10s of 1000s of families navigate very similar journeys, including Chelsea, who's joined us today.

How long is free to feed been around?

We're just about to hit six years. Okay.

Yes. So when in that time and how old is your daughter? Six then little little over six? Did any practitioner pediatrician lactation consultant, anybody suggests that it could be anything in your diet.

When my oldest first when I first took her in and said, You know she's inconsolable. She will not stop screaming. I don't know what to do. This can't be normal. I was told that yeah, you're just a first time mom. And babies cry. Good luck with that. And I was like, There's no way that anybody would have a second baby. This is the, you know, just babies cry. And what I took her back, when she was a few weeks old, she had an intensely bloody diaper. We woke up to just all blood in her diaper. And then I freaked out and took her back and said, Okay, well, now I know why she's been screaming at me for a few weeks. What do I do? How do I fix this and still at that stage, kind of pushed off and you know, kind of flippantly told it could be cow's milk, it might be that your baby has a food allergy to cow's milk and your diet, consider removing it, and that should fix the problem. And I did remove cow's milk protein from my diet, and she spiraled, she got worse really quickly, to the point where all that came out of her little body was blood and her eczema became so infected and leaking, that we were admitted to the hospital. And so free to feed it now has been in existence for almost six years. And a big part of what free to feed offers is not only the research and resources that I wish I had when I was navigating this with my daughters. But we also provide personal consultation services to teach the research and science really create a digestible platform for parents that are navigating this, which is how I met Chelsea, who's joined us today to share her own journey.

Kelsey, yes,

my name is Chelsea, I have a daughter who is now three years old. And I had the pleasure of meeting Dr. Trail through an unfortunate experience navigating food allergies with my daughter at the time as well, who presented with what someone would call classic colic symptoms. And I knew in my intuition that something was wrong. And it was not normal. And unfortunately, I could not find support in the world of pediatricians and I was continually told to try formula. And that the baby cried a lot, and so be it and kind of pushed off as a first time mom. And then once I had the opportunity to meet Dr. Trail, and we started working together, we started seeing improvement within my daughter's stool, her crying within a couple of weeks. But it took unfortunately a few months of working with Dr. trail to get my daughter to a baseline state. What was that process like?

It was difficult it once I met Dr. trill and I felt validated and what I was experiencing as a mother and again, as a first time mom, you think I'm doing it wrong, there's something I'm doing, I should be able to control this, I should be able to support my daughter. And I remember going to the pediatrician. And I specifically said that I wanted to keep breastfeeding my daughter. And there were two comments that were made because my daughter was failing to gain weight at this time as well. And the pediatrician, a male looked at my daughter and he goes all sweetie, do you have an eating disorder. And I am a first time mom recovering from a C section. It's during the time of COVID. Because this was 2021. I am in this pediatricians office without my husband. I'm a wreck. And I'm just doing everything in me to keep it together. And I left that appointment with samples of formula and told to try that and that that was the solution. So the initial beginning process was extremely difficult and emotional. But once I started seeing progress, and once I established a relationship with free to feed and Dr. trill. At least at that point, I knew that we were on the right track. And we were making progress. So it did get easier. But it was probably one of the most difficult things that I've had to navigate.

Well, Chelsea, we have you to thank for this episode, because you are a listener and follower of the Down to Earth show. And you reached out to me and you said I think that we need to do an episode on this trail, I had seen your page and follow your page and had actually wanted to get you on the podcast. And it was just one of those things that we hadn't gotten to yet. And so I am really, really, really happy to be talking about this topic today. Because obviously I am an ibclc. And I can tell you that in my years now this was a while ago that I got my first you know, certificate and training. Very, very, very little of this was talked about. Dr. Tina smiley, who was my mentor was the only one really at that time who was even talking about the possibility of mothers with hyper lactation, specifically with hyper lactation, having problems with protein transfer into the milk. So I think that there's probably even so much more information research since that time, and I'm really excited for you to talk to us about what moms can look for how this happens, why it happens how how common it really is, what are the differential diagnoses? And what do we do about it? Yeah, that's many questions.

So currently I it's clearly a topic I'm excited about.

Yeah, I'm really excited to dive in, I would say so first, those families who you know, may be listening or listeners who are concerned that they may be navigating food reactivity, but start with the symptoms to kind of keep an eye out on and I think that as you mentioned, there's there's multiple facets to food allergies and your lactation journey that has led to a lot of lack of education in this space, quite frankly. And some of it has to do with lack of proper funding for lactation problems, lack of proper funding for women based problems. And the first thing to know in when we're talking about the education side of things is that the types of food reactivity that Chelsea's kiddo navigated that my little ones navigated are now classified as non IGE mediated food allergies. And they didn't get diagnostic codes until 2017. As non white, non IGE mediated food allergies.

Can you explain that? Absolutely.

So when we think of a food allergy, we think stereotypically of Little Timmy getting a peanuts going into anaphylactic shock, there's swelling, there's hives, and he needs an epi pen in his mind, he's got to go to the hospital, right? That's what we think of stereotypically as a food allergy. That type of food allergy is categorized as IGE mediated. And the reason why it's categorized as that is because in our body, it is the immunoglobulin E or IgE, for short, antibodies that are responding to that peanut, for example. Now, what we have is a whole other category, that is everything. But unfortunately, they so we have lumped them as non IGE mediated food allergies, which simply means that it's a different pathway in the immune system in which these allergic responses are occurring, it is still a food allergy. So that's important to note, it's still a food allergy, not an intolerance. However, it's using a different pathway. It's typically different symptoms that we see for these kiddos. And the light at the end of the tunnel is that a vast majority of kiddos with non IGE mediated food allergies will outgrow that.

So that doesn't mean that if you're breastfeeding baby is responding to something that you're eating and has passed through your breast milk such as let's just say it's peanuts, then it that does not mean that you're breastfeeding baby is going to grow up to have a peanut allergy, is that correct? Correct.

Exactly, it means that your little one has depending on the symptoms that you're seeing, your little one most often will have a what's called a non IGE mediated food allergy, they may still have those symptoms when you go to introduce peanuts directly the blood and stool, the solubility, vomiting, things like that. But not that they are going to grow up to have a lifelong food allergy to peanuts, which is more often an IGE mediated food allergy. And so these diagnostic codes because we didn't get them in the US until 2017. That means that many providers are not up to date on these diagnostic codes that they are not familiar with the different categories that fit under those diagnostic codes. There's four or five categories depending on what research you're looking at, because it's still fairly new. That's based on where in the body the reaction is occurring. Everything from eczema, to vomiting to bloody stools and diarrhea. And while we have now these new diagnostic codes, we're also learning so much more about the prevalence for these types of food reactivities. And certainly, as I mentioned, these, those who are professionals, especially in ibclc realm, will I'm sure hear this and say okay, well, mucus in stool, got it. However, there are other things that can impact, you know, the stool consistency, latch and air aphasia other pieces of the puzzle that we need to take into consideration. And so when we think about prevalence, the most recent research that we have shows anywhere from and these numbers are probably going to knock somebody's socks off. But if the numbers currently are 19 to 35% of parents are actually recording these particular food allergic symptoms to the point where they can specifically give the food that's eliciting these types of allergic responses. And when the scientists take into account that there's likely other things going on and they dig deeper into that it lands at right around 25%. So one in four kiddos navigating these early early food allergy responses that are later outgrown, and even as we you know, talk to our family members and things like that. You may hear a lot of people in previous January shouldn't say oh, yeah, you know, your your uncle cried all the time. Do you think that maybe colic was really just his food allergy was food allergy?

I think that it's a really big contributing factor to food allergies. I think that that the food allergies were always there and that the the increase that we're seeing is largely based on awareness. It makes so much sense. And we've said for decades that what what have they said about colic? It's just basically a baby that cries an inordinate amount, a high number of days of inexplicable crying What is it like at least three hours a day our normal but at least three days a week for at least three weeks. If a baby is crying unusually often and fussing and squirming? We can just say they're just born fussy. But it just doesn't make any sense. So this probably explains the majority of them.

And not only that, but in no other scenario in our lives would be be okay with somebody who cries for three hours a day for three or more days is for three weeks.

Farming and fussing and like the riving and discomfort, right?

And yeah, in no other situation. And, you know, the, again, the rose colored glasses is that yes, they're going to outgrow it. But because of the scenario where like Chelsea and I mentioned going to the pediatrician and saying there's a problem and being dismissed. And then eventually they outgrow it. So that's oftentimes what we're told is just wait, just wait for baby to outgrow it. And yes, they likely will. In the meantime, though, that has major major impacts on the relationship between the parents and the child the relationships between the caregivers, the child's overall health, long term health and then the parents help mentally and physically so it one of the interesting and funny but not funny haha. Stories that I like to share is that my husband has ulcerative colitis he has for the last decade had ulcerative colitis. And when he first presented with blood and stool, he had a full panel right? He was admitted to the hospital, a full panel of tests and it was, you know, all hands on deck to figure out why he was in pain and he had bled in school until we got a diagnosis and the Help and Resources and moving forward. When my daughter had massively bloody stool. I was told maybe take cow's milk out of your diet given formula and sat home. And in what universe that's okay. Is is really baffling.

Because babies just, this is just a baby thing. This is just what babies have babies are just uncomfortable.

Was it not a cow's milk milk formula? was No, no, it can't be.

You have to be kidding. Yeah, no, no, I'm not getting it. Wait a minute, they told you to take cow's milk out of your diet when you were breastfeeding. But then they said Give your baby formula which is cow's milk that's happening every day. 1000s of times a day. Is this just me? Is it just me? Am I misunderstanding this? Trisha, you're laughing at me? I cannot believe this, the logic of it. Why? How can I tell a woman explain this? From their faulty way of thinking? It's something that has to explain it anyway. What are they thinking?

I have heard, I've heard lots of things. One of the theories that I have heard is that somehow and this is I want to just upfront say this is not in any way shape, or form the case that somehow the parents body when they're consuming cow's milk is like concentrating it and making it more concentrated than what you would find in the formula. Yeah, that is not what happens in the body. No, makes no sense. Not at all. And then on the other, you know, side of things when we were admitted to the hospital, because she was just so egregiously bleeding. We she was put on a 24 hour starvation diet. And they basically said don't feed her for 24 hours, which as a sidenote is super fun when you're physically the food, right? Like, I couldn't pump in her room because she would be so upset, rightfully so. Right. If someone told you you can't eat and then grill the steak and what do you give the baby like?

I do? Water they gave us they gave us a little thing of like Pedialyte Oh no, with a little nipple that like they were like, if you cannot get her to calm down, give her this you know, my my baby who already has quote unquote, colic. If you can't get her to calm down, here's a little bottle of a light food 24 hours and then they left. And so I remember like literally pumping in the stairwell at the hospital because I couldn't bring myself to pump into the room. And at that stage of the other end of 24 hours of not feeding her they said well, or bloodies told that a little better. So it's probably food allergies. That's how we got to that point, and they said your only option is to switch to a hypoallergenic formula at that point. So thankfully, at least they didn't give me a cow's milk based formula and told me not to drink cow's milk. However, the end at that stage like, I would have fed her literally anything like the dust bunnies under the bed. But at that stage, the kind of the other shoe drops that the hypoallergenic formula that we were told we had to go on, was $50. A can and only last a few days, and I was a grad student, and we can't go get another job. So I went from feeling like I was feeding my baby, something that hurt her to not being able to afford to feed her at all, which is where I started the conversations of okay, well, if you can make a hypoallergenic formula, Can Can I make hypoallergenic breast milk? Is that a thing that I can do? And I was told, you know, here's, here's a laundry list, literally just a laundry list of things that your baby could maybe be allergic to just remove all of them from your diet. And then I was shimmied out the door. And so I went on a very, very strict elimination diet. And I did it for a year. And I don't recommend other people do that.

And that was just a coincidence that you had this situation and you were a molecular biologist.

I was lucky one form for sure.

Can we hear Chelsea story? Let's let's fold into everything. You're teaching us through Chelsea's eyes. And through her case study, basically. Tell Sure. Yeah. Bring us back. Yeah, so when I first reached out to Dr. trill, and I got on the Zoom call with her, I thought to myself, let's see what happens. Maybe Maybe this isn't food allergies, maybe it is. And I told her the symptoms my daughter was having at the time, which were crying uncontrollably, cannot get her to settle. She had discolored stool. So her stool is like a very bright, sometimes dark green was stringy. It was mucousy it just looked abnormal. And she had the most severe diaper rash that I've ever seen sores that were opening on her bottom. And she was spitting up a lot. And again, I went to the pediatrician, I brought up these concerns, and I showed pictures of her diapers in the stool and they said, Oh, no, it looks normal. It's fine. And I explained that she was spitting up a lot. And they asked, Oh, she's a happy spitter. She upset when she's spitting up. But I started taking notes of in her crib at night, how far the split up was from her. And I started realizing that the split up in what she was having was projectile. And sometimes I would be holding her and it would be projectile spit up, that will come up and into the air. And there were all these other symptoms. So my first conversation with Dr. trill it was, yes, your baby is presenting with a lot of symptoms that very well could be food allergies. So at the time we discussed, what do we do from here? How do we assess knowing that non IGE mediated allergies we can't test for. So the best way to do it is through food elimination, and then re trialing. So I learned from Dr. trill at this time, there were 12, top food allergies for infants. And we decided to take these out of my diet for five days. And the reason being, and this is another huge myth that I see in the community quite often is people are told, okay, take cow's milk out of your diet. And it takes weeks or months for it to leave your breast milk. And I was fortunate enough to learn that that's not true. And Dr. trill you can speak to the research on that if you'd like. But what she told me is, that's just not true. So let's take it out, they will be out of your breast milk within 24 hours, that's even being on the safe side. And I eliminated those top 12 infant food allergies from my diet for five days. And I started seeing improvement in my daughter within those five days.

Dr. Trill, Can you speak to the reason that mothers are told that they need to eliminate these foods for at least two weeks when you know, and we know that it clears from the breast milk faster than that.

I think that's neither several points of contention there. So why that misinformation is so widespread. I was told the same when you were in the hospital, just a pump like a madwoman, well, you know this again laundry list of things, no cleared a quote unquote, from my diet for my breast, and that it would take weeks and even today we see parents that are told six to eight weeks of waiting, which is egregious and untrue. And so the actual research that we have where many researchers, many scientists actually before my time and now the last six years this has been my focus have done different types of dietary interventions. We did a large scale dietary intervention study with University of Idaho for example, with dairy and soy specifically 20 One data is collected human milk at many different time points and then stool from the parent and from the infant in many different time points, we're very excited to get that publication out very soon. And that's been years and years in the making. What we see is that when we consume a food, it spikes in concentration very quickly, just like all of the other molecules that we consume, right? Alcohol, flavonoids, most medications and lesser extended release, and they're meant to stay in your body for a really long time. Anything that's in the circulatory system can end up in the breast. And we are meant to transfer fragments of the proteins that we consume to the circulatory system, they have biological functions, they're so you're supposed to transfer fragments of proteins to your circulatory system into your breasts, there's nothing wrong with you. If your baby is navigating, you know, food reactivity issues, there's just two different things happening in two different bodies. And so what we see is that peak really quickly, and then if we're regularly removing breast milk, the milk is typically clear within eight hours. And we usually give a 24 hour window for outliers, right? Those individuals who have a faster, slower metabolism more or less hydrated, all of those things, right, your lactation schedule, there's there's many things at play here. And I think that the misinformation in this space is a few fold. One. I think that there's a big confusion around timing for transfer, versus the other two timings which is that the timing for a reaction and the timing for healing, right. So we have the timing of when I put something in my mouth to when it gets to my breast. And when it's clear from my breast. That's that's one, completely and still a very, very important point. Because when we're thinking about milk stashes, when we're thinking about, you know, slips or you know, when you consume something, and you're like, oh my gosh, it's going to be in my milk for two weeks, that that one little sentence that I just said fundamentally broke my relationship with food and that year of elimination for my daughter, because I truly believe that if I ate something, it would, my milk would, as I was told in the hospital poison, quote, unquote, my baby for two weeks. And that was heartbreaking. And so that's the first timing and very important for parents to know. The second timing then is when baby consumes that protein in the milk, we have two types of reactions, we can see we can either see an acute reaction, which happens fast and heals fast. Those are the hive reactions, the spit up the vomiting, reflux. And a lot of this upper GI reactions are happening fast and heal fast. And then we have the chronic, the chronic reactions take a little bit longer to happen. The sweet spot is six to eight hours after ingestion, but can take up to 48 hours because we're talking about lower GI reactions often. So you think if baby's not stooling, everyday, you may not see the blood in stool for up to 48 hours. So we say 68 hours is the sweet spot, but up to 48 hours versus see that reaction. And then they need time to heal. So chronic reaction takes up longer to happen longer to heal. And so for example, as my my oldest daughter was starting to heal, that blood is going down and the bloodstock going down because it's taking that long for cow's milk to lead my breast, it's going down because her body has a literal wound, and it needs to close and heal the gastrointestinal system is bleeding. And so things like eczema is a wound on the skin. Things like bloody stool is a wound within the gastrointestinal system that now needs to close heal. And that's where we're seeing day over day, a slow steady improvement. So yes, it may take several weeks, if your baby's very severe to see full healing, but it's not because you're melt continues to have the thing that you've eliminated from your diet. And what caused that wound exactly like is it the membrane around the intestines that is diminishing and becoming permeable and opening? Is it literally something happening to the cells of the membrane? It is is there blood there? I mean, is that is that what the wound is? So the wound is the immune system responding to the food itself. So it's a cellular response, where the immune system sends a response to that particular area where it sees the protein. And so this is similar to think about it from the standpoint of Have you ever eaten anything and you're talking about really tingly? Probably, or your mouth is tingly, for example. Very similar to this right where your immune system is eliciting a response and it's recruiting immune cells to that area and that allergic response is the immune system seeing something and deciding that it is a threat, and it's going to respond accordingly. Just like it sees your immune system sees a bacteria or a virus or a parasite and it responds accordingly with Here you go I'm gonna vomit that up because I don't actually like that thick bacteria that you just ate the food poisoning. And I'm also gonna baby shoot it out the back end too because I want it out of me. Right, same type of situation happens where the immune system is Miss identifying a benign item. In this case, we're talking about a food protein, it's Miss identifying a food protein as a threat and saying, I need to react accordingly and protect this person protect the body. And in this case, that can look like blood in stool as the cells are constricting, and responding accordingly.

I want to make sure we're really clear on one thing about the transfer into the breast and then the breast in to the milk, are we talking about a transfer of the protein because the mother is reacting to the food or the actual protein from the food that she is eating is digested, transferred through the breast into the milk, and that is causing the pain in the baby? A ladder?

Right? The ladder? Yes. And that's a really, really important clarification, because the first can happen as well. Yes.

So the first can happen. And this is where we get into the interesting conversations about the myths around like, don't eat broccoli, while you're breastfeeding, like the gassy foods or don't drink coffee, things like that, where, in reality, what was fascinating here is because there's two different bodies, and two different things happening in them. And the lactating individual, if they are consuming anything that elicits some a response, like it makes them very gassy, they will potentially more readily transfer all of the proteins that they're consuming, right. And so the same thing happens with coffee, where let's say, My baby's actually allergic to wheat. And every morning, I have a cup of coffee with my wheat toast. And we have issues. So every day that I that I eat this, and then one morning, I run out of coffee, I just have my wheat toast, and I still transfer, right because we're supposed to transfer but maybe I transfer a little bit less, because I'm not experiencing that GI distress that I get when I drink too much coffee. And so I see a lower reaction and baby and I think, Oh, it's my coffee, when in reality, it was my wheat toast the whole time.

Because it's digested differently in you before you breastfed, because my gastrointestinal system has been impacted, as I'm consuming.

So the more mothers reacting to what she's consuming, the more the transfer is through the milk. And we have research that is dug into that as it relates to mothers who have food allergies themselves. And so we look for those fragments of proteins that transfer if a parent is actively reactive. So those parents who have like celiac, especially if they are having any kind of reaction, we see a shift of an increase of how much they're going to transfer of these fragments of proteins. Now baby's reaction is separate, right, a different thing going on. It's the immune system deciding, Oh, I see this thing. It's a threat, and I'm going to respond accordingly. But that is separate from you know, the parent and whether or not and how they transfer.

So that's why you said both. This explains why it's so complicated and confusing. Okay, so she had a really important question.

And let me let me ask a question in the meantime, and hopefully, it'll help Trisha because it's about what she asked. From a molecular biology standpoint. There's proteins all over our body, we can consume protein, but then we digest and the proteins change. Does this end up in the blood because blood converts to breast milk? So when you gave the example of not having the coffee, the wheat toast digested differently, why and how the wheat toast isn't digesting differently, it's your transferability that is changing, why did it change because you have gastrointestinal distress, such as if if coffee causes you that you have to pass for many people, even if they're not aware of it,
which it does for many, many people, okay, and, and so anytime that you have a gastrointestinal or an immune response to a food, or medicine or otherwise, you are going to increase the transfer of everything that's in your system.

So in the case where there was no coffee, less was transferred, because the gut was not as irritated. And then it looked like wheat toast was the issue that caused less production or reaction,

we toasted your reaction from the gecko. But now when you have coffee, you transfer more wheat, because the coffee has irritated the gut making the gut lining more permeable, therefore the reaction is more severe. So this makes me think this is this is. So the reason that some mothers can eat whatever they want, and breastfeed and their babies aren't gonna have any issue has to do mainly with the mother's gut health and her gut integrity. Would that make sense?

It does make sense. Unfortunately, though, it's not the entirety of the story because we actually see that regardless as to how incredibly healthy the gastrointestinal system is. We all are going to transfer. And so the two pieces of the story is like, how much that parent transfers and how sensitive that baby is. So you can have the healthiest gastrointestinal system ever, literally like pristine black chef's kiss, you're still supposed to transfer proteins, it's it's a function of the gastrointestinal system, you have to, they are needed in your circulatory system. And so you can have a pristine gastrointestinal health. And if your baby's still very sensitive, that little bit that you transfer, still gonna cause a reaction. And then the other way around, were babies not very sensitive. But you transfer really, really readily, right? It's really high, you have food reactions, you have a crazy amount of stress. Cortisol is a huge one, and you transfer a lot. Even if baby sensitivity is not that high, the amount that you transfer now is still going to trigger the baby. And then yes, to your point, we have some parents who find out don't find out that their baby has food reactivity until they start solids, right? They're like I eat cheese every day all day. And Chelsea and I can be like, Darn you can choose every day all day. I never saw reaction when my baby and the first time I gave them cheese. I saw blood and stool what gives? And so there's two points to that there's the sensitivity level question, right is, does your transfer match like the sensitivity level of your kiddo? But there's a second piece, it's even more fascinating, which is, when we transfer a protein, let's say I like to use the visual for listeners of the alphabet, we think about protein, think about the alphabet ABCDE. Because when we think about what makes up a protein is amino acids. And in the science world, we like to use a letter to annotate each amino acid. So think about the alphabet, when I consume cheese, then there are many proteins that make up cheese. And let's think of one of those proteins being the length of the alphabet, in in length all the way from A to Z, when you all four of us consume that cheese, we are all transferring the same portion of that alphabet to the breast, let's say the LMNOP of that protein. So we don't transfer the whole protein. Because otherwise we're shooting peanuts out of our nipples would be a cool party trick, but not what happens, right, we break it down significantly. So we are all transferring the LMNOP of that protein. And the rest of it's more broken down and doesn't transfer, we don't find it in the breast. And it gets transferred into the circulatory system transfers into the breast. And the difference between Chelsea and I then as to let's say Chelsea's little one doesn't have a reaction is because when you have an allergic response, the protein is ident Miss identifying a portion of a protein. And so if Chelsea's baby is allergic to the ABCDE, got it shouldn't have that protein, and my baby's allergic to the LMNOP Chelsey and I could both eat cheese, and Chelsea will never see a reaction. And I will. And that is a really big differentiating factor to mention as well.

And that's why some people are allergic to many things, because that segment shows up in all of the different foods. Is that right?

Why yes. So this which is why for example, when we think about infants with food reactivity, many many kiddos who are reactive to cow's milk are also reactive to soy because that LMNOP is almost identical between certain soy proteins and cow's milk proteins.

So we need to definitely talk about like the top 12 foods that are most reactive and I feel now and I see that as soon as there is any type of Gi issue many mothers are being told, just straight up Alright, time to eliminate dairy now it's like over the top, everybody's eliminating dairy, they probably don't need to, and then they're going further. And they're eliminating corn, soy gluten. Pretty soon a mother who's postpartum and needs a lot of calories and nutrition is left with nothing to eat and a lot of stress. And that brings me back to the other question. Uh, you mentioned something about cortisol. And I wanted you to explain that. So if you could just touch on that quickly, what how cortisol relates to this, and then go through the, the top 12?

Absolutely. So as we're discussing things that can impact the gastrointestinal system and the immune system, one of the top items is cortisol levels, so your stress directly impacts your transferability. And so it ends up being really a rough cycle, right? The spiral, if you will, of I have a new baby, and postpartum. I am already stressed I'm trying to heal babies and consolable I quite frankly, is somebody who has navigated this I there is not anything that I've gone through that's more stressful for them an inconsolable baby, or a baby that's refusing to feed even though they're hungry, bloody stool, we saw vomiting, it's very, very stressful. So your cortisol level spikes and as your cortisol level is too high and you're over We're tired and all of those other things that impact your cortisol, you are going to increase your transferability, which increases baby's reactions and around and around we go. And so that spiral can be really, really hard for many parents, and is certainly a factor that we take into consideration when we're working with parents about like, what are some stress reduction tactics that we can use, while acknowledging that this is the most stress that you'll probably ever experience in your life, which is so very hard. And as we talk about the top triggers for infants, when Chelsea and I first met back in 2021, we had done some really big deep dives into the research behind what do we have for non IGE mediated food allergies because when you think of top allergens, right, or allergenic foods, there are there are topless, right via the FDA in the US and other you know, agencies and other countries that say these are the most likely foods to elicit a life threatening IGE mediated food allergy, right. And so, those foods are listed as such, because the FDA requires that food manufacturers are supposed to you right off the bat when big flashing lights are supposed to make it very clearly labeled on an ingredient deck that like, hey, this has milk. This has soy in it, this has peanuts in it, because it could cause a life threatening reaction in a certain amount of the population over a threshold. Right. That's how they decide they decide this food is considered a quote unquote top allergen because over this percentage of the population in the US could die from having this food because it could cause an anaphylactic shock reaction. For example, we just recently at the beginning of the year, added sesame to that list. Right, so now we have a top nine in the US instead of a top eight. Now what's important to note here is that our kiddos, a vast majority of them are not experiencing IGE mediated food allergies. And so the foods that are more likely to elicit an IGE mediated response, or not a one for one for the foods that are most likely to elicit a non IGE mediated allergic response. Many of the foods are very similar cow's milk, soy, wheat eggs, those are those are still top non IGE needed food allergies, so are peanuts and tree nuts. But then when you think about non IGE mediated food allergy is the more common foods that we'll see are things like oats, rice, corn, legumes, beef, and chicken, as opposed to things like fish and shellfish. For example, fish and shellfish are more often foods that cause IGE mediated food allergies later on in life and like adolescence and adulthood. That's interesting about oats because that's a really common one that mothers are eating for milk supply. Yes,

it is a very common one. And in fact, when we what we did next to so when Chelsea and I started working together, we used all of that research on like, what do we have so far, in addition to a study that's that free to theta just completed in 2021. Looking at those particular triggers, we have reinitiated that study, and last year, we had over 558 participants, many with multiple children that completed in our IRB approved study where we went all the way through everything from there was like 125 different data points per parent, which massive kudos to everybody who was a part of that study, because it took a long time to get through it. And what we did is we drill down even further and we said, Okay, now let's look at like, not just if you have an IGE mediated food allergy, here's the top 12 Instead, what are your specific symptoms, and what's the food that are more likely to cause that one symptom or three symptoms. And so now we've created a database and we're working hard towards and I'm gonna cross all my fingers. By the time this podcast airs will be submitted for publication. So then, when you're navigating this you can literally what we have is a tool that I can go in and say, Chelsea's baby has skin reactions, vomiting, and excessively mucousy stool, and then it'll populate based on all of our data. These are the specific foods for her based on her symptoms that are most likely to elicit an allergic response. Beautiful. If Chelsea's little one was experiencing vomiting, and that's the main symptom. The top four foods for her are dairy, soy, and then rice and oats in that order. That's incredible. That is incredible important to know.

I think the most important part and what my goal was in being guests on the podcast is to share information and to start having conversations and to stop victim shaming mothers into believing that they're the problem that their babies are having reactions. And I think again, we live unfortunately in In a society and a community of just deal with it, and we've done it in the past, and we need to be able to grow with the science and that's why my relationship with Dr. trill has been so important because the amount of information I have learned and it's then become a passion of mine to share this with other moms, and I'm not being paid to do it. And I still love you know, it's funny to say getting on Facebook groups and providing information and I just, it breaks my heart to see other mothers go through that process that I had to go through for six plus months until I was able to get to a good point. And Dr. trill and her team at free to feed have done the work to provide the support and the resources and now I feel like as a mother who experienced it myself, it's my job to help get that information out there to help share and have that conversation so that other mothers one don't feel alone and two that we can support mothers in the community and their babies as well.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

It depends on when you're collecting them. So if you're collecting them off very, very early guests it is going to be 4% The fat when you're lactating the fat hangs on is my scientific term for this clings on to the cells of the ducts of the dots as they're producing and so it's not until either you lactate enough that those kind of gets squeezed and it pushes the fat into the milk and so that will change the concentrations of of everything. Or if you before you start to feed give yourself your own little milkshake, if you will back also help and be impactful. But it depends on when you are collecting the milk as to what the exact concentration but it's between four and what percent foreign 10 Okay. Yeah, one thing I found very interesting in my education about food was that breast milk mirrors vegetables very closely. There's about the same amount of protein and vegetables as breast milk between five and 10%.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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